title: Detection of myocardial ischemia by vessel-specific leads derived from the 12-lead electrocardiogram and its subsets.
abstract: Currently used electrocardiographic criteria for identifying patients with ST-elevation myocardial infarction (STEMI) perform with high specificity but low sensitivity. Our aim was to enhance ischemia-detection ability of conventional STEMI criteria based on 12-lead electrocardiogram (ECG) by adding new criteria using 3 vessel-specific leads (VSLs) derived from 12-lead ECG. Study data consisted of 12-lead ECGs acquired during 99 ischemic episodes caused by balloon inflation in, respectively, left anterior descending coronary artery (LAD; n = 35), right coronary artery (RCA; n = 47), and left circumflex coronary artery (LCx; n = 17). ST deviation was measured at J point in 12 standard leads, and for 3 VSLs, its value was derived from 12-lead ECG by using 8 independent predictor leads or just a pair of precordial leads combined with a pair of limb leads. Mean values of sensitivity (SE) and specificity (SP) of ischemia detection achieved with conventional STEMI vs VSL criteria were then obtained from bootstrap trials. We found that the detection of ischemic state by conventional criteria achieved the mean SE/SP of 60%/96% in the total set of ischemic episodes, 74%/97% in the LAD subgroup, 60%/94% in the RCA subgroup, and 36%/100% in the LCx subgroup. In comparison, the mean SE/SP values of VSLs derived from 8 independent leads of 12-lead ECG were, at 125-microV threshold, 76%(*)/96% in the total set, 91%(*)/97% in the LAD subgroup, 70%/94% in the RCA subgroup, and 71%(*)/100% in the LCx subgroup (with asterisk denoting a statistically significant increase). The mean SE/SP of VSLs derived from some of the 4-predictor lead sets (namely, those including lead V(3)) matched or exceeded values achieved by VSLs derived from 8 predictors; for instance, with predictor leads I, II, V(3), V(6) derived VSLs attained at 125-microV threshold the mean SE/SP of 80%(*)/95% in the total set, 91%(*)/97% in the LAD subgroup, 74%/92% in the RCA subgroup, and 71%(*)/100% in the LCx subgroup. Based on these results, we conclude that, in our data set, 3 VSLs derived from the complete standard 12-lead ECG-and even from its subsets-can identify acute ischemia better than existing STEMI criteria.
authors.affiliation: Faculty of Medicine, Dalhousie University, Halifax, NS, Canada. milan.horacek@dal.ca
authors.forename: B Milan
authors.initials: BM
authors.lastname: Horácek
authors.forename: Maryam
authors.initials: M
authors.lastname: Mirmoghisi
authors.forename: James W
authors.initials: JW
authors.lastname: Warren
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.forename: John J
authors.initials: JJ
authors.lastname: Wang
mesh_terms: D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D017202:Myocardial Ischemia / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity